TY  - JOUR
A1  - Busch, Martin
A1  - Nadal, Jennifer
A1  - Schmid, Matthias
A1  - Paul, Katharina
A1  - Titze, Stephanie
A1  - Hübner, Silvia
A1  - Köttgen, Anna
A1  - Schultheiss, Ulla T.
A1  - Baid-Agrawal, Seema
A1  - Lorenzen, Johan
A1  - Schlieper, Georg
A1  - Sommerer, Claudia
A1  - Krane, Vera
A1  - Hilge, Robert
A1  - Kielstein, Jan T.
A1  - Kronenberg, Florian
A1  - Wanner, Christoph
A1  - Eckardt, Kai-Uwe
A1  - Wolf, Gunter
T1  - Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease - cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort
JF  - BMC Nephrology
N2  - Background

Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD.

Methods

The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18–74 years with an estimated glomerular filtration rate (eGFR) between 30–60 mL/min/1.73 m2 or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure.

Results

At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25th–75th percentile: 6.8–7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m2, 95 % CI 1.02–1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04–1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26–7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77–6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides.

Conclusions

Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels.
KW  - Chronic kidney disease
KW  - Glycaemic control
KW  - Hemoglobin A1C
KW  - Insulin therapy
KW  - Oral antidiabetic drugs
KW  - Diabetes mellitus
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-164687
VL  - 17
IS  - 59
ER  - 
TY  - JOUR
A1  - Pilgram, Lisa
A1  - Eberwein, Lukas
A1  - Wille, Kai
A1  - Koehler, Felix C.
A1  - Stecher, Melanie
A1  - Rieg, Siegbert
A1  - Kielstein, Jan T.
A1  - Jakob, Carolin E. M.
A1  - Rüthrich, Maria
A1  - Burst, Volker
A1  - Prasser, Fabian
A1  - Borgmann, Stefan
A1  - Müller, Roman-Ulrich
A1  - Lanznaster, Julia
A1  - Isberner, Nora
A1  - Tometten, Lukas
A1  - Dolff, Sebastian
T1  - Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease
JF  - Infection
N2  - Purpose
The ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study’s aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD.

Methods
We analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified.

Results
Comparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15–65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27–33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66–147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49–54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17–8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13–10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68–1.93, p = 0.611).

Conclusion
The identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2.
KW  - chronic kidney disease
KW  - COVID-19
KW  - LEOSS
KW  - predictive factor
KW  - SARS-CoV-2
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308957
SN  - 0300-8126
SN  - 1439-0973
VL  - 49
IS  - 4
ER  -